Face Radiance Rediscovered

Beauty tips on how to makeover aging skin and regain a youthful glow

If Snow White wore low-rise jeans and had a cell phone surgically attached to one hand, she would look like my cousin Eden. The girl is undeniably lovely. But the first time I really paused to consider the source of her prettiness was during Thanksgiving dinner last year. There I was, fork midway from plate to mouth, staring obsessively at her cheeks. Her daisy-fresh, glowing, porcelain-and-pink-in-exactly-the-right-places cheeks. They looked like my cheeks. Correction: my old cheeks.

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Shit, I thought, very nearly hurling my brussels sprouts across the table at her. I'm aging.

Of course, Eden is 16. At twice her age, I don't expect to look exactly like her. Over the past few years, winky little creases have developed around my eyes, faint parentheses around my mouth. A smallish, bean-shape blotch set up shop on my right cheekbone. To these assaults, I have—ahem—turned the other cheek. Minor invaders, I thought. Not worth the fight.

But the contrast between our complexions seemed somehow more global. The problem wasn't one isolated spot; it was my whole face. We're both extremely fair, but while she appeared moonlit (even in broad daylight), I looked reddish, oily, uneven. Dull.

The loss of one's "glow" is not as ephemeral as it sounds. The term is actually rather concrete. Skin's appearance is all about optics. Ideally, light penetrates the complexion's top layers, is diffused laterally, and reflects back out. Like a mirror or a body of water, the smoother and clearer the surface, the more light it reflects. Conversely, the less even and translucent it becomes, the more light it absorbs. This decline happens so slowly, you almost can't recognize it. One day radiance is there, the next day it's not.

Well, I'm not going out like that. Glow may be easily lost, but it's also easier to restore than ever before, thanks to dermatology practices teaming with $100,000-plus machines, all humming in concert, just waiting to zap our sins away. If you've got the time and the money—big ifs nowadays, to be sure—dermatology has the tools to get the job done. (For the record, I have neither time nor money, but I have a job in which vanity can be written off as "work.")

And so, the week after Thanksgiving, I undertake a dermatological tour of New York City. First stop, the Fifth Avenue office of Arielle Kauvar, MD. I am secretly hoping Kauvar will send me packing: "You, aging? Get outta town!" But it quickly becomes clear this is not going to happen.

She outlines Problem One: slacker cells. At 16, Eden's dead cells slough off of their own accord, revealing plump, healthy new ones. But my older, lazier cells are more inclined to stick around, creating a cloudy, uneven layer that obscures light. Optically speaking, the process is like a layer of dust gathering on a glossy table or, as Kauvar attractively phrases it, "like viewing your skin through a callus."

This is not exactly breaking news: An entire exfoliation industrial complex—part of which regularly topples out of my bathroom cabinet—exists solely to get aging cells up and at 'em. Microdermabrasion, peels, and scrubs (both in-office and at-home) whisk away dead layers, while an ever-expanding family of vitamin A derivatives—prescription retinoids such as Retin-A, Tazorac, and Renova, plus OTC versions of retinol and retinoic acid—speeds up lagging turnover.

"Fabulous," I tell Kauvar. "So let's get me peeled and prescribed, and my glow and I will be on our way."

But we are far from finished. Radiance, I soon learn, is the sum of many parts. Kauvar informs me that my small constellation of mouse-brown spots—so minor, one might even confuse them with "cute" freckles—is, in fact, Problem Two: overzealous pigment. Cells' brown pigment, or melanin, is designed to absorb harmful UV rays, which is why populations that originated closer to the equator tend to have more of it (and why my northern European ancestors—built for gloom, apparently—possessed the bare minimum). We pump out extra melanin as a protective mechanism, but under the oxidative stress of sun exposure, smoke, hormonal fluctuations, and mental stress, this production can go haywire, leaving us with permanent lentigines, or sunspots.

Whether these deposits are visible on skin's surface or microscopic and diffuse (I have a bit of both), they absorb light. The effect can be surprisingly aging: Studies have shown that excess pigment, even if it's invisible to the naked eye, alters our perceived age as much as the traditional enemies, lines and wrinkles.

My main coloration problem, however, is not brown, but pink. Problem Three—to put a less adorable spin on the old Holly Golightly saying—is the "mean reds." What was once peaches 'n' cream is now more like a light but permanent sunburn on my nose and cheeks. In actuality, it's a subterranean network of capillaries rendered defunct, primarily by sun damage, which "can appear as visible, large blood vessels or less distinct vessels, creating visible patches of redness," Kauvar says. Again, I've got both; neither reflect light.

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The next stop on my dermal expedition is the office of Anne Chapas, MD, a thirtysomething who looks like she gets about 18 hours of sleep per night—whatever "glow" is, she's got it. Chapas seems most distressed by Problem Four (Come on, now. Four?): pothole pores. "Part of luminosity is skin's own volume," she explains. "A plump, thick dermis reflects more light." While volume loss makes me think of sagging skin (thankfully, I'm not there yet), and pore size seems like an acne issue, Chapas points out that it all goes back to collagen. That's what makes cells nice and fat, thereby keeping pores small and tight. Large pores—mine are none too small—are "a sign that skin's losing its luster," Chapas says almost wistfully.

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Right. So now that we've identified the Fantastic Four, what to do about them? While professional-strength exfoliators such as peels and microdermabrasion certainly help rev up radiance, their effects are relatively minor and short-term compared with what both docs say I need: Lasers.

Kauvar proposes a multilateral attack. "I often do two or three different lasers in one session, one after another," she explains. (There's something Wild West about this declaration. I picture her in a Chanel suit and a gunslinger's belt, a laser in each hand: Quick-Draw Kauvar!) She says a pulsed dye Vbeam would seal blood vessels and break up excess pigment; a diode Smoothbeam would heat the dermis, skin's underlayer, for collagen stimulation. Both devices are nonablative—they would leave skin's surface intact, with only brief redness—and would do the job in three or four monthly treatments, plus touch-ups every six months or so.

Chapas, on the other hand, recommends the Fraxel Re:Store, "the gold standard for pore size." The first of a relatively new breed of procedure—fractionated resurfacing—Fraxel pinpoints between 5 and 50 percent of skin's surface (depending on the desired depth of the treatment), searing microscopic shafts of tissue through the skin's upper layers. Healing requires three to five days of what the laser's website terms "social downtime" (a classic beauty industry euphemism: Technically, you can leave the house with a red, slightly oozy face, but you probably won't want to). The idea, Chapas says, is removing excess pigment while stimulating collagen. "It takes 100 days for new collagen to build," she says. "Within three to four months, lines improve and pores shrink. The results can last for years."

Still, my skin slog wasn't finished. At last, I arrive at the Park Avenue practice of Macrene Alexiades-Armenakas, MD, PhD, a laser specialist and unrepentant science geek. Here's where she wins me over: Alexiades' entire office literally buzzes with technology, but the first gizmo she whips out is
a relatively low-key spectrophotometer. Roughly the size of a home video cam, the device actually quantifies radiance, measuring how much of each wavelength of light the skin reflects and how much it absorbs. Alexiades gently presses the camera's small, circular lens to my nose, cheeks, forehead, and chin. The results confirm her suspicion. Redness tops my list of problems.

She continues her inspection, turning my head to the side and arriving at my brown patch. "Have you had this checked out before?" she says. "It's a little rough. How long has it been there?" I have a lengthy, complicated family history of skin cancer; this kind of talk makes me very nervous, very fast. So when Alexiades says this could be an actinic keratosis, a small, crusty patch or bump that can turn into skin cancer, I'm pretty much on board for whatever she wants to do to it.

Ultimately, Alexiades says I need photo­dynamic therapy (PDT), a treatment for precancerous cells that she invented in 2001, when she was fresh off her medical residency (the breakthrough earned her an industry reputation as a wunderkind). In PDT, a photosensitizing solution called aminolevulinic acid (ALA) is applied to skin. When activated by light, it binds to mutated cells, killing them. The patient knows it's working because, afterward, these spots dry up and flake off. PDT can be done with a pulsed dye laser, intense pulsed light (IPL), or blue-light laser; in my case, Alexiades chooses the aforementioned capillary-targeting Vbeam.

Happily, PDT has a host of other glow-boosting benefits, as well. It also zaps acne, shrinks oil glands, has some lightening effect on brown spots, and contracts capillaries to calm redness and rosacea. Best of all, in my case—since the damage is still minor—the treatment would be short and relatively painless, and should do most of the work in a single session.

The next week, I'm back at her office at 8 a.m., barefaced and optimistic. The entire session takes less than 45 minutes: five to apply the ALA, which makes my face feel tight and mildly itchy; 30 to let the chemical sink in; and 10 for the actual lasering. Blinded by protective goggles, I can't see what she's doing, but I can hear it: The laser emits a startling, staccato pinging sound as it inches along the contours of my face. It stings slightly, like a rapid, repeated electric shock, but Alexiades is quick; before anxiety takes over, she's done.

PDT makes skin ultrasensitive to light for 48 hours; sun or even strong indoor light can easily burn skin, causing extreme, painful redness and lengthy healing time. So I obediently scurry home, draw the blinds, and hunker down for two days under Le Hood (this is not a term of endearment. It's what this effective but criminally ugly sun hat—picture a wide white brim with an attached shoulder-length do-rag—is called) with only the flicker of Oprah to guide my way. I may have looked like a terrorist, but house arrest works: I experience zero pain. My skin is slightly blotchy for a day, and my brown spot never peels—a sign that it wasn't precancerous after all.

A month later, I can tell it worked. My skin is bright again; it's far less oily and not as prone to flushing, and my pores seem a bit tighter. When I return to Alexiades for a follow-up, the spectrophotometer offers proof: I have 23 percent less redness and a 15 percent drop in brown pigment. There are still some stubborn red dots on my nose from broken capillaries, which Alexiades offers to zap again with the Vbeam (sans ALA) if they bother me. But they don't. I don't need perfection; I just want my glow back. And I've got it—for now.